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Wednesday, July 20, 2016

It is truly remarkable how radically Western societies were remade
by the baby boomer generation. They campaigned for the decriminalisation of
abortion and succeeded in most liberal democracies. As Carole Levine rightly
notes, ‘the women’s movement of the 1960s and 1970s was a frontline attack on
(the) patriarchal and authoritarian model’ of decision-making in the medical
profession.[1]
Baby boomers also campaigned for the decriminalisation of same sex acts and
eventually brought us marriage equality, even in a country as conservative as
the United States. They campaigned for the decriminalisation of (soft) drugs
and we are beginning to see increasing numbers of jurisdictions dabbling in the
decriminalisation of at least cannabis. This, of course, is also partly due to
the failure of the war against drugs. Restrictive drug legislation is reportedly
responsible for about 5 billion people’s lack of end-of-life access to opioids
across the globe.[2]

With baby boomers being anywhere between 52 and 70 years of
age, invariably the end of life is coming into focus for an increasing number
of people belonging to this generation. They would have seen parents and
relatives suffering often terribly at the hands of a medical system that
ignored their end-of-life choices in favour of life support at nearly all cost.
Even today about 35% of patients who are at the end of the life receive
non-beneficial medical care, including care that will result in a deterioration
of their quality of life, such as, for instance, radiotherapy and dialysis.[3]
Bioethicists have long proposed a patient focused approach to these kinds of
challenges. Robert Veatch, for instance, noted that ‘the arrogance of the
medical professional claiming that he or she (mostly ‘he’) had the authority to
decide, even against a patient’s wishes, what was best for the patient was
morally indefensible. Physicians were deciding not only that continued
torturous life-support was in a dying person’s best interest, but that the
physician’s ‘order’ justified continued infliction of that torture. That ethic seemed so wrong, so contrary to
any moral decency, that it was only natural to challenge it in the name of
patient rights.’[4]

It is not terribly surprising, with baby boomer finding
themselves – perhaps to their greatest surprise - at the levers of power of the
system that they rebelled against in the 1960s and 1970s, that the number of
jurisdictions that have decriminalised assisted dying is steadily increasing. Many
legislators and judges are baby boomers. Just like baby boomers fought hard for
the right to live their life by their own lights, they were bound not to hand
control over to others when it came to their own dying. Their own foreseeable
demise has clearly focused minds in many a jurisdiction and highest court room.
The debates about supposedly significant moral distinctions between active
forms of assisted dying and letting die – never an ethically plausible
distinction to begin with - seem to have quietly faded away in favour of
respect for considered patient choice. Today’s debates focus on the potential
for abuse affecting disabled people and vague others labelled ‘vulnerable’ by
those campaigning against medical aid in dying. Where you stand on these
questions is not that significant as they will be settled by empirical evidence
that is accumulating rapidly in the increasing number of jurisdictions that are
decriminalising medical aid in dying in different forms and shapes. As I write this
the Canadian parliament voted in favor of legislation that would make
euthanasia and assisted suicide available to competent terminally ill patients.
The availability of legal access to euthanasia is a first in North America. The
state of California passed assisted suicide legislation a few months ago. It
came into effect in June 2016. Access to assisted suicide in California is
limited to terminally ill patients. Similar efforts are underway in a number of
other states in the USA. France decided, also in 2016, to introduce a terminal
sedation regime for eligible patients. Step by step baby boomers successfully wrestle(d)
away control over our dying from the medical profession and restrictive
legislation.

The next frontier for our baby boomer legislators and
judges, undoubtedly, will be the issue of scope, when it comes to assisted
dying. Should it be patient choice, irreversibility of the disease condition
and unbearable quality of life as decision-making criteria, or should impending
death be added as another necessary condition. The former arguably gels with
the ‘my life, my body, my choice’ attitude that drove most of the political
campaigns that led to the societal changes mentioned earlier. Historians of
bioethics will hopefully keep a
watchful eye on these developments.

Monday, July 18, 2016

I'm afraid the list isn't quite complete as for some reason at least one well-known quality publication, the Kennedy Institute of Ethics Journal, just doesn't pop up. It's also the case that some journals that were covered in the past have disappeared from google's radar, even though they continue to exist. This info from google's media release might explain the inclusion and exclusion of particular journals: 'Publications with fewer than 100 articles in 2011-2015, or publications that received no citations over these years are not included.'

Quite possibly the below table will be displayed in odd ways on your screen, mea culpa. Usual CoI blurb applies. I co-edit two of the journals in this list. List up-dated July 2016.

*h5-index is the h-index for articles published in the last 5 complete years. It is the largest number h such that h articles published in 2010-2014 have at least h citations each

**h5-median for a publication is the median number of citations for the articles that make up its h5-index